Description

Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada's peer-reviewed journal of obstetrics, gynaecology, and women's health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada.

Publications in this journal

• Ovarian ectopic pregnancy after in vitro fertilization.

  Authors: Caitlin Dunne, Jon C Havelock

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):409.

• Enforcing the assisted human reproduction act.

  Authors: Françoise Baylis

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):415.

• Routine third trimester control ultrasound examination for low-lying or marginal placentas diagnosed at mid-pregnancy: is this indicated?

  Authors: Daniel Blouin, Carolane Rioux

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):425-8.

  Objective: To determine what proportion of placentas described as low lying or marginal at the mid-pregnancy ultrasound examination are still so described in the third trimester, necessitatingObjective: To determine what proportion of placentas described as low lying or marginal at the mid-pregnancy ultrasound examination are still so described in the third trimester, necessitating delivery by Caesarean section. Methods: A retrospective chart review of all women delivering at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) from April 1, 2009, to March 31, 2011, was undertaken, and placental location at the mid-pregnancy ultrasound examination was noted. For all cases in which the placenta was described as previa (complete, partial, marginal, or low lying), the control third trimester ultrasound examination, when performed, was revised and so was the mode of delivery, vaginal or Casearean section. Results: During the study period, 5618 women delivered at the CHUS, and 4884 (86.9%) of these women had an ultrasound examination performed at the CHUS at mid-pregnancy. The placenta was described as low lying or marginal in 412 cases (8.4%). A third trimester control examination was performed in 376 cases (91.2%), and the placenta was still described as low lying or marginal in six cases (1.5%). Four of these 412 women (0.9%) had Caesarean sections for placental reasons. Conclusion: The vast majority (98.5%) of women with low-lying or marginal placentas at the mid-pregnancy ultrasound examination had normally located placentas in the third trimester, and less than 1% of these women had a Caesarean section for reasons that could be associated with the placental location.

• Postpartum depression: diagnostic and treatment issues.

  Authors: Verinder Sharma, Priya Sharma

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):436-42.

  Postpartum depression is the most common psychiatric complication of child-bearing. Despite the potentially deleterious effects of postpartum depression on the mother and her infant, the disorder isPostpartum depression is the most common psychiatric complication of child-bearing. Despite the potentially deleterious effects of postpartum depression on the mother and her infant, the disorder is often unrecognized and untreated. Women may be reluctant to seek professional help because of the stigma of mental illness, or they may be unwilling to try medication because of concerns about safety during lactation. In this review of postpartum depression, we discuss its clinical presentation, diagnosis, differential diagnosis, and treatment.

• Cervical screening: a guideline for clinical practice in ontario.

  Authors: Joan Murphy, Erin B Kennedy, Sheila Dunn, C Meg McLachlin, Michael Fung Kee Fung, Danusia Gzik, Michael Shier, Lawrence Paszat

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):453-8.

  Objective: To develop guidelines to inform the Ontario Cervical Screening Program's invitations to women in the target population, provide evidence-based clinical practice guidance for practitioners,Objective: To develop guidelines to inform the Ontario Cervical Screening Program's invitations to women in the target population, provide evidence-based clinical practice guidance for practitioners, and inform policy decisions. Methods: A systematic review was conducted of relevant websites, the Medline and EMBASE databases (2005 to November 2010), and the Cochrane Library (2005 to 2010). No guidelines or systematic reviews were located that addressed the topics of interest. The evidence base consisted of seven randomized controlled trials, three case-control studies, one cohort study, and one review article. A methodologist performed data identification and extraction. Review of the data and quality assessment was carried out by the authors, who have expertise in methodology, gynaecologic oncology, pathology, and family medicine. The systematic review methods and resulting recommendations were reviewed by an internal panel with clinical, methodological, and oncology expertise. External review was provided by Ontario clinicians and other experts. Conclusions: The guideline development process led to recommen-dations for the optimal primary cervical screening method, screening interval, and age of screening cessation for Ontario women in the target population. There was insufficient evidence to provide a recommendation for age of initiation of cervical screening with HPV testing. The creation of an organized screening program in the province will allow the implementation of evidence-based recommendations. We provide interim recommendations for cervical screening until HPV testing has been funded.

• A novel approach to the surgical management of clitoral phimosis.

  Authors: Jamie Kroft, Michael Shier

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):465-71.

  Background: The objective of this case series was to outline a novel method for surgical correction of clitoral phimosis caused by vulvar lichen sclerosus (LS) or lichen planus (LP) and to review theBackground: The objective of this case series was to outline a novel method for surgical correction of clitoral phimosis caused by vulvar lichen sclerosus (LS) or lichen planus (LP) and to review the postoperative outcomes. Case Series: We used the CO2 laser to treat clitoral phimosis in 20 women with LS and three women with LP. All patients underwent individualized preoperative and postoperative topical therapy with steroids or immunomodulators. Five women with LS had mild reagglutination during follow-up but were satisfied with the results, and three required reoperation, with satisfactory results in follow-up. Two women with LP required reoperation. Conclusion: This novel surgical technique has enabled the treatment of clitoral phimosis secondary to LS or LP, but further studies are required. Medical maintenance therapy postoperatively is a vital component of treatment.

• A Rooming-in Program to Mitigate the Need to Treat for Opiate Withdrawal in the Newborn.

  Authors: Zoë G Hodgson, Ronald R Abrahams

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):475-81.

  Objective: The purpose of this study was to explore the effect of our rooming-in protocol on the need to treat withdrawal in the opiate-exposed newborn. Methods: We reviewed the medical records ofObjective: The purpose of this study was to explore the effect of our rooming-in protocol on the need to treat withdrawal in the opiate-exposed newborn. Methods: We reviewed the medical records of mother-infant dyads born between October 1, 2003, and December 31, 2006, who received care in our rooming-in program. Data on the type of drug used by the mother, maternal methadone dose at delivery, morphine treatment of the baby, and perinatal outcome were considered. Results: We found a significant positive relationship between maternal methadone dose at delivery, "other opiate" use, and breastfeeding and the need to treat the neonate for withdrawal. We also found the maternal methadone dose at delivery to be related to the duration of pharmacological treatment of the neonate. Conclusion: Our findings suggest a role for our rooming-in program in mitigating the relationship between maternal methadone dosage and the need to treat opiate withdrawal in the newborn. Consideration of the role played by the mother-infant dyad model of care needs to be considered in future studies.

• Counselling considerations for prenatal genetic screening.

  Authors: Lola Cartier, Lynn Murphy-Kaulbeck

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):489-93.

  This document has been developed to aid clinicians in counselling patients about prenatal screening and to provide assistance in counselling about both positive and negative screening results.

• Rethinking cervical cancer screening.

  Authors: Dirk Van Niekerk, Gina Ogilvie, Dianne Miller

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):411-2.

• Pregnancy outcomes among solid organ transplant recipients in british columbia.

  Authors: Robert A Humphreys, Helen H L Wong, Ruth Milner, Mina Matsuda-Abedini

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):416-24.

  Objective: Since 1954, over 14 000 women have given birth after having had an organ transplantation. Unfortunately, some women and physicians remain misinformed about the feasibility and outcomes ofObjective: Since 1954, over 14 000 women have given birth after having had an organ transplantation. Unfortunately, some women and physicians remain misinformed about the feasibility and outcomes of pregnancy post transplantation. Our primary objective was to assess their perceptions and difficulties with regard to becoming pregnant. Our secondary objectives were to determine the incidence of pregnancies among transplant recipients in British Columbia and any maternal, graft, or fetal complications. Methods: From 1997 to 2007 in British Columbia, there were over 500 female recipients of solid organ transplants. We surveyed recipients in this group who were of child-bearing age. Results: One hundred forty of 295 (47%) eligible recipients responded: 44 of these women had attempted pregnancy after transplant, and 31 women gave birth to 47 children. One half of the respondents planned to have children post transplant; 108 of 140 (77%) had no children before transplant. One quarter of the respondents were advised against pregnancy by their physician, and 33% of these women found a new physician to support their pregnancy. Rates of miscarriage (27%), rejection (21%), and prematurity (65%) were higher than expected. Infections were rare, and no birth defects or noteworthy health problems in the offspring were reported. Conclusions: Overall, pregnancy appears to be safe following solid organ transplantation, but careful monitoring and counselling are recommended.

• Anti-d in rh(d)-negative pregnant women: are at-risk pregnancies and deliveries receiving appropriate prophylaxis?

  Authors: Lawrence Koby, Ami Grunbaum, Alice Benjamin, Robert Koby, Haim A Abenhaim

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):429-35.

  Objective: Although anti-D prophylaxis has greatly reduced the rate of Rh-immunization, there remain women who sensitize during or after pregnancy because of inadequate prophylaxis. The purpose ofObjective: Although anti-D prophylaxis has greatly reduced the rate of Rh-immunization, there remain women who sensitize during or after pregnancy because of inadequate prophylaxis. The purpose of this study was to compare adherence to prophylaxis recommendations for antenatal and postnatal anti-D immunoglobulin administration. Methods: We conducted a retrospective cohort study of all pregnancies recorded at the Royal Victoria Hospital between 2001 and 2006 to determine the rates of antenatal and postnatal prophylaxis in Rh(D)-negative women. We compared adherence to anti-D prophylaxis recommendations between our institution's physician-dependent antenatal approach and the protocol-based postpartum approach. Logistic regression analysis was used to estimate the odds ratio and 95% confidence intervals of determinants of non-adherence to current recommendations for anti-D prophylaxis. Results: Antenatal administration was analyzed in 1868 pregnancies in eligible Rh-negative women. Among these women, 85.7% received appropriate antenatal prophylaxis and 98.5% of eligible women received appropriate postnatal prophylaxis. Factors independently associated with non-adherence to antepartum prophylaxis included first visit in the third trimester (P < 0.001), transfer from an outside hospital (P = 0.03), and physician licensing before 1980 (P = 0.04). Conclusion: Unlike hospital-based protocol-dependent systems, physician-dependent systems for antenatal anti-D prophylaxis remain subject to errors of omission. A more standardized system is needed to ensure effective antenatal prophylaxis.

• HPV Testing in Primary Cervical Screening: A Systematic Review and Meta-Analysis.

  Authors: Joan Murphy, Erin B Kennedy, Sheila Dunn, C Meg McLachlin, Michael Fung Kee Fung, Danusia Gzik, Michael Shier, Lawrence Paszat

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):443-52.

  Objective: Previous findings from cross-sectional studies have shown human papillomavirus (HPV) testing to be more sensitive than cytology testing for primary cervical screening. This systematicObjective: Previous findings from cross-sectional studies have shown human papillomavirus (HPV) testing to be more sensitive than cytology testing for primary cervical screening. This systematic review aims to assess whether the increase in baseline detection with HPV testing corresponds to lower rates in subsequent screening rounds. Methods: We searched Medline, EMBASE, and the Cochrane Library for randomized controlled trials (published from 2005 to 2010) comparing HPV-based and cytology-based cervical screening. Primary outcomes of interest were relative rates of higher grade cervical intraepithelial neoplasia and invasive cervical cancer. Secondary outcomes included test performance characteristics and colposcopy referral rates. Results were pooled where possible using a random effects model. Results: Seven randomized trials were identified. Across studies, HPV testing was more accurate than conventional cytology and detected significantly more CIN3+ in the first screening round (Mantel-Haenszel [M-H] risk ratio 1.67; 95% CI 1.27 to 2.19) and significantly less in the second screening round (M-H RR 0.49; 95% CI 0.37 to 0.66). There were no differences in pooled rates of CIN2+ (M-H RR 1.19; 95% CI 0.94 to 1.50) and CIN3+ (M-H RR 1.09; 95% CI 0.84 to 1.42), but there was a higher pooled rate of CIN2 (M-H RR 1.37; 95% CI 1.12 to 1.68) over two screening rounds. A trend towards lower rates of invasive cervical cancer was observed.

• Pregnancy Rates in Older Poor Responders Who Achieve Embryo Transfer in Long Down-Regulated ART Cycles Are Comparable to Those in Younger Poor Responders.

  Authors: Tevfik Yoldemir, Ian S Fraser

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):459-64.

  Objective: To determine whether older women with a poor response to follicular stimulation achieve pregnancy results that are comparable to those of younger poor responders. Methods: Two hundred fiveObjective: To determine whether older women with a poor response to follicular stimulation achieve pregnancy results that are comparable to those of younger poor responders. Methods: Two hundred five women undergoing in vitro fertilization treatment at the Fertility Unit in the Royal Prince Alfred Hospital in Sydney, Australia were selected for retrospective cohort analysis. The outcomes in women > 38 years of age with < 5 oocytes retrieved were compared with those in women ≤ 38 years who also had < 5 oocytes retrieved. Clinical and ongoing pregnancy rates were compared. Results: Implantation rates (21.01 ± 0.38 % vs. 12.82 ± 0.27%, P = 0.11) and clinical pregnancy rates (25.71 ± 0.44% vs. 20.21 ± 0.40%, P = 0.41) were similar in the two groups following cleavage stage embryo transfer. The same was true for blastocyst stage embryo transfer (implantation rates 16.67 ± 0.33% vs. 13.89 ± 0.33%, P = 0.80, and clinical pregnancy rates 23.81 ± 0.44% vs. 16.67 ± 0.38%, P = 0.59). Ongoing pregnancies beyond the 12th week of gestation were also comparable between cleavage stage (24.28 ± 0.43% vs. 16.84 ± 0.34%, P = 0.24) and blastocyst stage embryo transfers (23.81 ± 0.44% vs. 11.11 ± 0.32%, P = 0.32). Conclusion: If older poor responders reach the stage of embryo transfer, they can achieve pregnancy rates similar to those of younger poor responders when matched numbers of embryos are transferred.

• Delivery by caesarean section in super-obese women: beyond pfannenstiel.

  Authors: John C Kingdom, David Baud, Kirsten Grabowska, Jacqueline Thomas, Rory C Windrim, Cynthia V Maxwell

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):472-4.

• Management of group B streptococcal bacteriuria in pregnancy.

  Authors: Victoria M Allen, Mark H Yudin

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(5):482-6.

  Objective: To provide information regarding the management of group B streptococcal (GBS) bacteriuria to midwives, nurses, and physicians who are providing obstetrical care. Outcomes: The outcomesObjective: To provide information regarding the management of group B streptococcal (GBS) bacteriuria to midwives, nurses, and physicians who are providing obstetrical care. Outcomes: The outcomes considered were neonatal GBS disease, preterm birth, pyelonephritis, chorioamnionitis, and recurrence of GBS colonization. Evidence: Medline, PubMed, and the Cochrane database were searched for articles published in English to December 2010 on the topic of GBS bacteriuria in pregnancy. Bacteriuria is defined in this clinical practice guideline as the presence of bacteria in urine, regardless of the number of colony-forming units per mL (CFU/mL). Low colony counts refer to < 100 000 CFU/mL, and high (significant) colony counts refer to ≥ 100 000 CFU/mL. Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to February 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values: Recommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care (Table). Benefits, Harms, and Costs: The recommendations in this guideline are designed to help clinicians identify pregnancies in which it is appropriate to treat GBS bacteriuria to optimize maternal and perinatal outcomes, to reduce the occurrences of antibiotic anaphylaxis, and to prevent increases in antibiotic resistance to GBS and non-GBS pathogens. No cost-benefit analysis is provided. Recommendations 1. Treatment of any bacteriuria with colony counts ≥ 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. (II-2A) 2. Women with documented group B streptococcal bacteriuria (regardless of level of colony-forming units per mL) in the current pregnancy should be treated at the time of labour or rupture of membranes with appropriate intravenous antibiotics for the prevention of early-onset neonatal group B streptococcal disease. (II-2A) 3. Asymptomatic women with urinary group B streptococcal colony counts < 100 000 CFU/mL in pregnancy should not be treated with antibiotics for the prevention of adverse maternal and perinatal outcomes such as pyelonephritis, chorioamnionitis, or preterm birth. (II-2E) 4. Women with documented group B streptococcal bacteriuria should not be re-screened by genital tract culture or urinary culture in the third trimester, as they are presumed to be group B streptococcal colonized. (II-2D).

• Meigs' syndrome.

  Authors: David J Quinlan

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):311.

• Planned caesarean hysterectomy versus "conserving" caesarean section in patients with placenta accreta.

  Authors: Shigeki Matsubara

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):317-8.

• A multidisciplinary checklist for management of suspected placenta accreta.

  Authors: Amira El-Messidi, Angela Mallozzi, Lawrence Oppenheimer

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):320-4.

  Rates of abnormally invasive placentation have been escalating. The condition requires meticulous planning to ensure safety at delivery. Although placenta accreta remains the most common reason forRates of abnormally invasive placentation have been escalating. The condition requires meticulous planning to ensure safety at delivery. Although placenta accreta remains the most common reason for Caesarean hysterectomy in developed nations, medical and surgical therapies have allowed fertility preservation. Most planning strategies start with risk factor assessment and diagnostic imaging. Early planning of arrangements for antepartum and intrapartum management is preferable to late planning, when emergency situations are more likely to occur. Based on maternal and fetal morbidities, and published evidence of factors that may diminish these risks, we have developed a checklist to aid the antepartum and intrapartum management of potentially challenging cases of invasive placentation or to aid in considering tertiary care consultation and transfer. The proposed checklist may best benefit physicians working in primary and secondary levels of care in Canada. Ideally, this checklist would be available in electronic form, with alerts as needed; a copy of the checklist should be kept in the patient's medical chart, with periodic updates.

• The influence of changing post-term induction of labour patterns on severe neonatal morbidity.

  Authors: Victoria M Allen, Andrew Stewart, Colleen M O'Connell, Thomas F Baskett, Michael Vincer, Alexander C Allen

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):330-40.

  Objective: To estimate the influence of changing practice patterns of post-term induction of labour on severe neonatal morbidity. Methods: This population-based cohort study used data from the NovaObjective: To estimate the influence of changing practice patterns of post-term induction of labour on severe neonatal morbidity. Methods: This population-based cohort study used data from the Nova Scotia Atlee Perinatal Database to evaluate the effect of post-term induction of labour on stillbirth and neonatal mortality and severe neonatal morbidity in low-risk pregnancies. The study population included all pregnant women ≥ 40 weeks' gestation delivering in Nova Scotia from 1988 to 2008 who underwent induction of labour with a single fetus in cephalic presentation. Major congenital anomalies and pre-existing or severe gestational hypertension and diabetes were excluded. Women delivering post-term from 1994 to 2008 (after the Post-term Pregnancy Trial) were compared with women delivering from 1988 to 1992 to evaluate outcomes with changing maternal characteristics and obstetric practice patterns. Results: Evaluation and comparison of time epochs (1988 to 1992, 1994 to 1998, 1999 to 2003, and 2004 to 2008) demonstrated an increased risk for perinatal mortality or severe neonatal morbidity, especially low five-minute Apgar score, among both nulliparous and multiparous women. There were no significant differences in the risks for stillbirth or perinatal mortality over time. Comparable relationships were demonstrated in a subgroup of lower risk women. Conclusion: The increase in post-term induction of labour with time is associated with a significant increase in severe neonatal morbidity, especially among infants born to multiparous women. Evaluation of the antepartum and intrapartum management of these low-risk pregnancies may provide additional information to reduce morbidity.

• Serious preeclampsia among different immigrant groups.

  Authors: Marcelo L Urquia, Ivan Ying, Richard H Glazier, Howard Berger, Leanne R De Souza, Joel G Ray

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):348-52.

  Objective: Research conducted outside Canada suggests that preeclampsia (PET) may be more common among certain ethnic groups. A limitation to prior studies is that they did not distinguish betweenObjective: Research conducted outside Canada suggests that preeclampsia (PET) may be more common among certain ethnic groups. A limitation to prior studies is that they did not distinguish between immigrant and non-immigrant women; they also included women with mild PET arising near term, the clinical importance of which is debatable. We created the term "serious PET" to describe a diagnosis of severe PET, eclampsia, or any degree of PET with concomitant preterm delivery, fetal death, or maternal hospitalization of seven days or more, and evaluated its risk in association with world region of origin among recent immigrants to Ontario. Methods: Using the federal Landed Immigrant Data System database (LIDS), we completed a population-based study of 118 849 women who immigrated to Ontario between 1985 and 2000. The LIDS was linked to the Canadian Institute for Health Information's Discharge Abstracts Database, thereby capturing all hospitalizations with subsequent delivery in Ontario between April 1, 2002, and March 31, 2009. Rates for serious PET were determined according to maternal world region of birth, and odds ratios were adjusted for maternal age, number of live births, multifetal pregnancy, diabetes mellitus status, level of formal education, place of residence, neighbourhood income quintile, duration of residence in Canada, and fiscal year of delivery. Results: Immigrant women from the Caribbean (6.8 per 1000; OR 3.34; 95% CI 2.25 to 4.96), Sub-Saharan Africa (6.8 per 1000; OR 3.14; 95% CI 2.04 to 4.83) and Hispanic America (5.9 per 1000; OR 3.11; 95% CI 1.97 to 4.88) were at highest risk of serious PET relative to immigrant women from industrialized nations. The ORs were either unchanged or higher when restricted to women without a prior live birth. Conclusion: We identified immigrant groups at higher risk of serious PET, whose consequences would presumably include greater financial costs for hospital care and a negative impact on maternal and newborn well-being.

• Multidose methotrexate treatment of cervical pregnancy.

  Authors: Helene S Weibel, Abdulrahman Alserri, Caroline Reinhold, Togas Tulandi

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):359-62.

  Background: Cervical pregnancy is a rare form of ectopic pregnancy. The treatment ranges from medical treatment with methotrexate to hysterectomy. Cases: We report two cases of cervical pregnancyBackground: Cervical pregnancy is a rare form of ectopic pregnancy. The treatment ranges from medical treatment with methotrexate to hysterectomy. Cases: We report two cases of cervical pregnancy with fetal cardiac activity that were successfully treated with multidose methotrexate. Conclusion: Due to the possible severe complications of cervical pregnancy and its surgical management, multidose methotrexate treatment in hemodynamically stable women is an appropriate option.

• Assessing residents' disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality.

  Authors: Glenn Posner, Viren Naik, Erin Bidlake, Amy Nakajima, Benjamin Sohmer, Abeer Arab, Lara Varpio

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):367-73.

  Objective: The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examinationObjective: The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examination (OSCE) using a standardized patient (SP). We hypothesized that the addition of a simulated clinical adverse event prior to the SP encounter could increase trainees' engagement and empathy, thereby improving performance. The objective of this study was to explore whether experiencing a simulated adverse event prior to an SP encounter alters resident performance on a disclosure OSCE. Methods: Sixteen obstetrics and gynaecology residents participated in this mixed methods study. Prior to disclosing the complication in an SP encounter, residents were randomized either to receive a written description of an adverse event, or to experience a mannequin simulation of an adverse event. Mean OSCE scores from blinded examiners were compared in each group. Focus group discussions elicited residents' reflections on the experience of disclosing the adverse event. Results: The mean score was 16.6/23 ± 2.9 (range 10 to 20) for the traditional OSCE group and 16.9/23 ± 1.7 (range 15 to 20) for the simulation group. Analysis of the focus group data revealed several themes, such as the type of context the residents desired, the emotional involvement they felt, and their insights about their experience of the simulation scenario or with the SP. Conclusion: The assessment of adverse event disclosure was not enhanced by the addition of a simulated experience. Study participants reported that the simulation did not provide the contextual information required to elicit empathy and a sense of being emotionally invested in the adverse event.

• The PIERS Experience: Research or Quality Improvement?

  Authors: Tabassum Firoz, Laura A Magee, Beth A Payne, Jennifer M Menzies, Peter von Dadelszen

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):379-81.

• A climate of safety.

  Authors: Timothy Rowe

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):313-4.

• Why vaginal breech delivery is an acceptable option.

  Authors: Savas Menticoglou

  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC. 34(4):318-9.

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.